Emergency Tracheostomy: Indications and Technique

Abstract

Tracheostomy, the creation of a surgical opening into the trachea, was probably first performed by Asclepiades (Greek physician, c. 129-40 BC). The early operations were associated with a very high mortality and became an established technique only during the late 19th and early 20th century, when a large number were performed on patients suffering from diphtheria. Today, the majority of tracheostomies are performed electively or semi-urgently. Percutaneous tracheostomy is a minimally invasive alternative to conventional tracheostomy. The kit required to create a full-sized percutaneous tracheostomy is widely available in the UK. Hence, this technique is widely practised in ICUs in the UK. Various techniques are involved in performing tracheostomy techniques via the percutaneous method, and are outside the scope of this article. A true emergency tracheostomy is relatively uncommon and the most likely cause is upper airway obstruction (Figure 1), where the patient cannot be intubated. In almost every other case, such as the patient with mechanical respiratory insufficiency, initial management will be by endotracheal intubation.